Correlation Analysis Of Clinical Efficacy And TOAST Classification After Intravenous Thrombolysis In Acute Cerebral Infarction

【Objective】To compare the clinical efficacy of intravenous thrombolysis with alteplase in patients with acute cerebral infarction with different TOAST classification,further analysis and screening of independent risk factors affecting the clinical efficacy of intravenous thrombolysis in patients with different TOAST types of acute cerebral infarction,better guidance for clinical intravenous thrombolytic therapy,improve the safety and reliability of intravenous thrombolytic therapy.【Method】Through retrospective analysis,the patients with acute cerebral infarction who received intravenous thrombolysis of alteplase in the Advanced Stroke Center of China-japan Friendship Hospital of Jilin University from May 2020 to September 2021 were counted.All patients with cerebral infarction were divided into LAA（Large artery atherosclerosis）group,CE（Cardiogenic embolism）group,SAO（Small artery Occlusion）group,SOE（Stroke of Other Determined etiology）group and SUE（Stroke of Undetermined etiology）group according to TOAST classification（Due to the small number of SOE and SUE groups,it is easy to bias the results of the study,so this paper will focus on the first three types）,A total of 142 patients who received intravenous thrombolysis were collected after removing SOE and SUE groups.All patients had onset time within 4.5 hours and received standardized intravenous thrombolysis with alteplase.NIHSS score before intravenous thrombolysis and NIHSS score immediately after thrombolysis were collected from all patients.Short-term neurological function improvement before and after thrombolysis was evaluated based on the above results,so as to evaluate the early effect of thrombolysis.Meanwhile,prognosis at 3 months was evaluated by the modified Rankin scale score（MRS）.Based on the CT results immediately after thrombolysis,the subjects were divided into HT（Hemorrhagic Transformation）group and non-HT group.Independent risk factors for HT were screened,and the predictive value Y was calculated by multi-factor logistic regression method.The diagnostic validity of logistics regression model was tested by ROC curve.【Result】A total of 142 patients were included,including 120 males and 22 females.According to TOAST classification,there were 70 cases of large aorta atherosclerosis（LAA）,19 cases of cardiogenic embolism（CE）and 53 cases of small artery occlusion（SAO）,including 108 cases of anterior circulation and 34 cases of posterior circulation.According to head CT reexamination,21 cases were divided into HT group and 121 cases were not HT group.1.There were no significant differences in early effect and long-term prognosis after intravenous thrombolysis in LAA type,SAO type and CE type acute cerebral infarction patients within the time window（P >0.05）.2.The higher the NIHSS score immediately and the longer the ONT time after thrombolytic therapy,the worse the early curative effect（P<0.05）.3.The higher the NIHSS score before and immediately after thrombolytic therapy and the history of coronary heart disease,the worse the long-term prognosis（P<0.05）.4.LAA type and CE type were more likely to develop HT than SAO type（P<0.05）.Groups of gender,age,body mass index,time to see a doctor,the baseline of blood pressure,history of stroke and TIA history of medical history,history of hypertension,diabetes,coronary heart disease,atrial fibrillation history,history of smoking,drinking,fasting glucose,glycosylated hemoglobin,homocysteine,triglyceride,low density lipoprotein cholesterol,high-density lipoprotein cholesterol,platelet count,uric acid,creatinine,FIB and There was no significant statistical significance in infarction sites（anterior and posterior circulation）（P >0.05）.【Conclusion】1.There was no significant difference in immediate effect and long-term prognosis after intravenous thrombolysis in LAA type,SAO type and CE type acute cerebral infarction in time window.2.The higher the NIHSS score immediately and the longer the ONT time after thrombolytic therapy,the worse the early efficacy.3.The higher the NIHSS score before and immediately after thrombolytic therapy and the history of coronary heart disease,the worse the long-term prognosis.4.LAA type and CE type are more likely to develop HT than SAO type after intravenous thrombolysis.